Prevention of Type II Diabetes with Lifestyle Change

Executive Summary

The write-up is a Request for proposals (RFP) targeted to Kansas Health Foundation (KHF). It discusses in detail the initiatives of TD Program meant to manage type II diabetes in underserved or at-risk –adults with low levels of education and lower incomes-  populations by utilizing four structural components. They are healthier food initiative, tobacco initiative, physical activity initiative, and life transformation lessons. The healthier food initiative is a plan which focuses on intensifying access to healthier food products in Kansas communities that are underserved.  The tobacco initiative, on the other hand, seeks to find different types of brief interventions to a diverse group of people who have type II diabetes and subsequently helping them to cease smoking. The physical activity initiative attempts to advocate for physical activity and physical education in institutions, preferably schools. Its objective is to ensure that the schools adhere to international benchmarks of physical activity. Also, to warrant that the physical activity culture embedded in the student will stick permanently. Lastly, the Life Transformation Lessons surface aim is to educate the public on the risk factors of type II diabetes. Additionally, it assists them in gaining life skills that will enable them to cope with the lifestyle changes effectively. The hidden motive of these lessons is to identify external factors that hinder lifestyle changes to at-risk people in different locations. Generally, the program intends to establish evidence-based strategies that will lead to the implementation of policy, systems, and environmental interventions. The vision of KHF is to create a nation where all Kansans have a healthy life and make logical choices where they work, play, and live. To do this, the funding priority of the foundation will go to programs that increase physical activity, reduce the use of tobacco, and increase access to food and care. Thus, the foundation of the design of the TD Program. The significance of the program is to aid in the synthesizing of effective interventions meant to adopt lifestyle changes in multiple sectors. It will, in turn, reduce the damages posed by type II diabetes.

Statement of the problem

According to reports, the risk of developing type II diabetes escalates with age. Specific ethnic and racial groups show to have high rates of the disease. It is more prevalent to Hispanics, Africa American, and Asian Americans than for Caucasians. American Indians in the south part of Arizona have the highest rates of diagnosed diabetes globally. In 2012, diabetes caused over 1.5 million deaths globally. If individuals do not change their lifestyles, WHO estimates that worldwide deaths will double before 2030.

From studies, there is no specific cause for Type II diabetes; nonetheless, it is believed to be caused by a combination of lifestyle elements and genetics. Additionally, it is associated with risk factors like high blood pressure, excess body fat, older age, and family history. Managing and treating the disease is required as soon as it is diagnosed.

In 2017, the American government spent $327 billion medical costs on diabetes, and in 2012, reduced performance resulting from diabetes led to productivity losses of $20.8 billion. Diabetes brings about detrimental damages due to its high prevalence- the many risk factors it is associated with. However, diabetes, or preferably type II diabetes, can be easily prevented by lifestyle changes. It includes eating healthy, physical activity, managing stress, ceasing smoking, and regular checkups (Pietrangelo, 2019).

Literature Review

Health disparities between racial and ethnic groups are mostly attributed to the level of education and poverty. Bestowing to Kansas Health Foundation (KHF), the underserved populations suffer the most. In the entire nation, Kansas ranks seventh with the highest number of adults who are obese. This problem is highly concentrated to the lower socioeconomic status. These health statistics are evident in all health-related problems. For instance, out of three individuals who have not attained their high school education, one uses tobacco, whereas out of ten people with a degree in college, only one is involved in substance abuse.

Ablah et al. did research in 2013 intending to define the prevalence of diabetes in the urban and rural populations of Kansas. They collected data from over18,000 respondents through telephone lines. Choosing of the participants was through stratified random sampling and analysis conducted by SAS and logistic regression. From their results, the prevalence of diabetes was higher in rural areas than the urban ones. More so, lower levels of educational attainment and low incomes were linked with high rates of pre-diabetes and diabetes. The rural Latinos had the highest prevalence of 19.3% and African American (22.9%) the uppermost in the urban regions. This study supports the report from KHF, and they attempt to advocate that implementation of lifestyle changing programs to these racial groups is a must.

Albright states that the clearest and most robust evidence for mitigating type II diabetes is by carrying out a structured lifestyle intervention. The initiatives will address physical activity and nutrition. He further implies that multiple studies are in favor of these, and the methods are cost-effective. It is defended by the works of Dunkley et al. in their meta-analysis and systematic review. They summarized the effectiveness of diabetes prevention programs, which were based on lifestyle changes. Through meta-analysis and meta-regression, they deduced that pragmatic prevention programs are active, and they can be improved by maximizing standard adherence (2014).

Public Health Models

Human behavior plays a significant role in health maintenance and prevention of illness. Years of concerted efforts have led to the establishment of models of behavior alteration and interventions calculated to influence the behaviors of an individual. Social action theory incorporates the lifestyle changes to a group of individuals with type II diabetes. This method is founded on social cognitive learning theory, underlying biological processes, and self –regulation model to predict behaviors and outcomes.  The theory views individuals in regards to how the environmental context influences them when they bring a specific biological and temperament context. In general, this model element- like social, biology, and environmental context-  dictate the realization of interventions to facilitate behavior change of an individual (Pellmar et al., 2002). This model of public health is best suited to the TD program. It is because the program aims to change the lifestyle of individuals with type II diabetes. From the work of Lo et al., lifestyle activities like smoking, physical inactivity, and excessive drinking, are linked with a cognitive function that is reduced. In short, the authors declare that lifestyle changes are behavioral and can be altered by the three fundamental concepts of the social action theory. For instance, in the Healthier Food retail, an intervention of TD Program provides the at-risk populace with healthier products (environmental element), therefore better managing their conditions.

Steps for the planning of the TD Program

TD Program Goals

The objectives of TD (type II diabetes) program is to carry out initiatives that will provide room for the collection of multispectral data. The data obtained will then be used to implement interventions that favor and support lifestyle change. The adopted lifestyle transformation will be the goal of the program, which is the reduction of the prevalence of type II diabetes. Therefore, reducing health disparities in Kansas and improving the quality of care.

Program Design

The governance structure in the program will be concentrated at the highest level of authority. Choosing this model of governance will offer strategic advantages; therefore, effortlessly responding to significant risks and challenges. The aim of centralizing will be to enhance the decision-making process and to save costs through disinvesting in the administrative’s lower levels. The governing body will defend and direct the performance of the public health program by carrying out five significant functions. They are contributing to the development of policies, ensuring there are sufficient resources, engaging with partners, exercising lawful authority, and monitoring advances.

The workforce constitutes four managers at the highest level, with all of them having degrees in masters of Public Health. The individuals work in different domains of the health systems. The admin deals with curative services, two work in preventive and care services, while the fourth one is a health educator. On top of the management, the workforce will contain individuals with mixed discipline and distinct experiences. The people are dietitians, physical activity instructors, and advisory experts. The diverseness of specialists will positively affect the performance (Rechel 2018).

The program will have four initiatives; Healthier Food Initiative, Tobacco Initiative, physical Activity Initiative, and Life Transformational Lessons. The initiatives will be conducted on underserved populations – the regions concentrated with at-risk individuals. However, few campaigns of the lesson intervention will be carried in socially and financially advantaged areas to comprehend the differences better. The overall program intends to survey a population size of more than 50,000, which will mainly be expedited by the lesson and tobacco initiative.

The requirements and objectives that increase the chances of getting funded by KHF are evidence-based initiatives that can meet their four priorities. That is increasing physical activity, reducing the use of tobacco, increasing access to healthy food, and care for populations in the at-risk group. In solving all these problems, the program will encompass several initiatives that will be interconnected in certain operations, structures, and management.

Healthier Food Initiative

Over the years, healthy food is being made accessible to the populations, mostly the underserved, by enhancing the food retailing environments. Mainly, it is achieved by enacting state policies which make supermarkets and grocery suppliers to set up in the underserved population areas and to improve their quality of products. Furthermore, reports indicate that individuals close to full-service grocery stores have lower levels of obesity as their diets are healthier- their intake of fruits and vegetables is exceptionally high. On the other hand, minority communities, people with low-income levels, and residing in rural areas, mostly have access to corner stores or small groceries as there are limited or no supermarkets. These stores stock little products due to lack of space and equipment. Also, they may charge extra on the available healthy foods. This phenomenon leads to the neighboring communities finding it hard to maintain a nutritious diet, thus affecting their health.

The team will carry out an initiative meant to provide informed information on the Food Retail in Kansas. The management and administration of this team will entail a chairperson, secretary, and market manager with their work focusing on articulating the objectives and aims of the project. The market of foodstuffs impacts multiple sectors of the community. The health food initiative will involve diverse partners like the retailer’s community, food producers, state agencies, and local authorities.

Working Process

The working procedure will initiate by convening partner groups and the key stakeholders who will assess the issue. The collaboration with non-traditional associates in the grocery, transportations, and agriculture firms will be achieved by mentioning beneficial overlapping goals. For instance, low-to-no cost strategies.

Other strategies that will be employed involve seeking help from advisory groups.  These experts are in a better position of investigating the issue and providing recommendations. Then determine if there are existing state programs or policies that have parallel goals with the initiative. This strategy is beneficial as it will consume less time to enforce the efforts than commencing new policies- all that will be required is expanding the policies. Finally, there will be echoing mechanisms to the policymakers through educating the community.

Physical activity Initiative

Every individual in society schooled at a particular time in their life. Additionally, these settings highly elevate physical activity. A considerable number of schools offer physical education globally, however not effective as it is of low quality- has not met the international standards. This initiative will target institutions, mostly schools, because it is easy to cultivate the regime to these locations. Also, because this activity has more health benefits like subsidizing the mental, emotional, and physical development in children.

The initiative will utilize the Comprehensive school physical activity strategy. This framework is essential as it improves both physical education and physical activity. It will guide the physical activity program in schools by exposing the students to many opportunities during school time as well as after and before school. This task will be carried out by two individuals who will pinpoint a champion of the activity in the institution. Typically, it will be a teacher as they are role models for young persons. This individual will then recruit other players from the surrounding, assess the opportunities, evaluate then finally implement.

Additionally, we will train the teacher so that he will guarantee that the early experience creates lifelong behaviors and interests in this group. This culture will stimulate them to further partake in sports and other exercise practices.

Tobacco initiative

This initiative structure will be divided into two; SBIRT intervention and cessation services. Results from the two areas will then be recorded and presented to the policymakers. According to SAMHSA, the SBIRT method is best preferred as it is brief- it takes a modal time of roughly 5-10 minutes. The technique is universal and can be able to identify specific problematic behaviors. Finally, it is supported by substantial empirical evidence.

SBIRT can be serviced by any healthcare practitioner, in any setting- for instance, primary care, trauma centers, and hospital emergency rooms. In the case of this initiative, the work will be conducted by clinical officers in hospitals. SBIRT denotes screening, brief intervention, and referral to treatment. It is a comprehensive approach to public health and delivers interventions and treatment early to individuals that are at-risk of developing substance use disorder. It is employed in multiple substances, like tobacco, alcohol, prescription medicines, among others. However, in the program, it will be used to offer interventions in tobacco abuse.

The initiative will commence by carrying out screening to patients with type II diabetes. It is crucial because it will identify individuals using tobacco, and more so, the severity of the substance abuse.  It will aid in the proper choosing of intervention level and the treatment required. At this stage, tools like CRAFT and NIDA quick screens can be incorporated, which serve as ways for collecting data. The brief intervention follows the screening phase, and single or multiple meetings characterize it. The main motive in this phase is to increase the awareness and insight of the tobacco victims on matters regarding substance use. The behavioral transformation will be possible through motivational enhancement. The intervention will be tailored in accordance with the setting and can be applied as a standalone treatment. For individuals who will not be managed by the brief intervention, will be referred for a treatment plan. The final part of SBIRT is a measure of its strength, and it involves collaborative efforts between the providers of SBIRT and the referral resources.

Lifestyle transformation Lessons

The lifestyle transformation program will be conducted for a whole year and integrate physical activity and nutrition lessons. Its main aim will be to identify the underlying factor that reinforces the type II diabetes risks in the at-risk populations- leading to evidence-based interventions- and subsequently educate. Individuals will know how to lower the risks of the disease and improve health.  Apart from these, it will serve as a marketing strategy for the program. The educational intervention will entail three key elements. An approved curriculum, support groups, and lifestyle instructors. The instructors will be a registered dietitian and will lead the programs. A pilot program will be run to retrain them and to ensure that they meet the expectations to encourage and motivate the audience skillfully. They will also expedite discussions and assist in making an entertaining environment. The support group will streamline the whole process. It is because they will support and offer advice to the program, evaluate processes, and ensure communication and dissemination of information is effective. Overall, they will provide guidance and direction on the development of the project.

An open application procedure will select groups of at-risk populations. Applications will be spread through social media and the press. There will be a selection criterion whereby the groups will show readiness to participate, should consult members prior to application, and they should agree to involve other supporters in the community.

As stated, the plan will run for a whole year. In the first six months, meetings will be held once in a week, and the next months, the seminars will reduce to two per month. A full lesson will be carried out in two seminars. The first part of the seminar will touch on ways to cope with stress, how to choose healthy foods when buying groceries, or eating out. More so, to supplement physical activity in a person’s life. The second segment will boost the skills of the group, thus able to maintain changes. The lesson will emphasize the setting of goals, overcoming challenges, and methods of staying motivated.

First Year Budget

Evaluation and Implications

Healthier Food Initiative

Data to be presented to the policymakers will be collected, analyzed, and reported by the team. The first step will entail identifying communities in Kansas that lack access to adequate food retailing stores and those that sell healthy foods at high prices. Activities here include the mapping of areas with high numbers of at-risk or underserved populations. It will be a prerequisite to have experts in Geographical Information system mapping.

Fact sheets and other provisions will then be prepared from the health data of those areas to show the need for the objective of the initiative. The collected data will also highlight the benefits that will be accrued by the multiple partners, and it will include mostly the cost-benefit data. In attracting more customers, the report will portray the health impacts, community revitalization, and economic development anticipated through revenue generation and creation of jobs. Lastly, the reports will be presented to the subject matter experts with knowledge in policy development and healthier retail improvement.

Physical activity Initiative

For a practical evaluation and implementation, the champion, together with his team, will receive support implementation resources advocated by Nihiser in her article. The documents are A Guide for Developing Comprehensive School Physical Activity Programs, School Health Index, and School Health Guidelines to Promote Healthy Eating and Physical Activity. The first document has a template for the program process from development, evaluation to implementation. The second one will allow the facility to assess its practices and policies related to health, inclusive of physical activity. In the third one, the school will have a better understanding of the methods, thus exposed to more opportunities for the implementation of physical activity (Pray, 2015).

Several indicators in this section exist. Foremost, the total number of hours that are offered at the institution in a period and is measured weekly. Secondly, how many hours are optional and how many are mandatory. Another indicator that will be used in evaluating is whether the health-enhancing undertakings were in the curriculum module of the instructor’s physical education. Furthermore, if it was optional or mandatory in their curriculum.

Tobacco initiative

In deducing of the reports, the results from the CRAFFT screening test and NIDA Quick screen will get used. The former screening test is used to screen for substances related problems facing adolescents. CRAFT is useful in providing important data on selfs. It is a self-report questionnaire administered by a provider. By using it, data on how long the patient has abused tobacco, and situations that reinforced his action will be obtained. Furthermore, it will provide the consequences of substance abuse.

Implications

Multiple pieces of evidence have confirmed the effectiveness of SBIRT in the reduction of unhealthy tobacco and alcohol use. More so, reports indicate that there are analogous models to SBIRT that can be used to address mental health issues and drug abuse. However, SAMHSA commends for researches to be intensified on the SBIRT model alternatives. They should be studied in servicing research, comparative effectiveness, and demonstrations.

Other screenings and intervention plans are defined in the category of SBIRT programs. Caution should be taken as some are yet to accomplish the standards. Lastly, it is essential to note that the effectiveness of SBIRT is dependent on its application, fidelity, and comprehensiveness.

Lifestyle Transformation Lessons

To ensure the groups comprehend what they will be taught, a training evaluation will be conducted on the sessions. It will be through pre and post-training questionnaires. They will evaluate the knowledge of the participants before and after the lesson. Furthermore, the participants will be required to answer specific questions that will benefit public health practitioners. The support group, together with experts, will evaluate the program and suggest areas of improvement in the educational lessons or collection of new valuable information.

Reflection

The successful completion of the RFP will show that the student has garnered the communication skills required in the writing of professional projects. Additionally, it will indicate that the student has comprehensively understood the systems of public health. The systems include the ability to diagnose and scrutinize problems of health and hazards in a community. The outcome of the project will enhance their human relations skills from a theoretical perspective.

References

Ablah, E., Dong, F., Cupertino, A. P., Konda, K., Johnston, J. A., & Collins, T. (2013). Prevalence of diabetes and pre-diabetes in Kansas. Ethnicity & disease, 23(4), 415-420.

Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., & Khunti, K. (2014). Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes care, 37(4), 922-933.

Lo, A. H., Woodman, R. J., Pachana, N. A., Byrne, G. J., & Sachdev, P. S. (2014). Associations between lifestyle and cognitive function over time in women aged 40–79 years. Journal of Alzheimer’s Disease, 39(2), 371-383.

Pellmar, T. C., Brandt Jr, E. N., & Baird, M. A. (2002). Health and behavior: the interplay of biological, behavioral, and social influences: summary of an Institute of Medicine report. American Journal of Health Promotion, 16(4), 206-219.

Pietrangelo, A. (2019, May 28). What You Need to Know About Type 2 Diabetes. Healthline. Retrieved February 16, 2020, from https://www.healthline.com/health/type-2-diabetes#managing-type-diabetes

Pray, L. (Ed.). (2015). Physical Activity: Moving Toward Obesity Solutions: Workshop Summary. National Academies Press.

Rechel, B. (Ed.). (2018). Organization and financing of public health services in Europe: country reports (No. 49). World Health Organization.